Predictors of herpes zoster vaccination among Australian adults aged 65 and over.

OBJECTIVE(S): To estimate HZ vaccine coverage in Australia among older Australians and to identify potential barriers to vaccination. DESIGN: Analysis of data from three cross-sectional surveys administered online between 2019 and 2020. SETTING AND PARTICIPANTS: Adults aged 65 and over residing in Australia. MAIN OUTCOME MEASURES: Self-reported herpes zoster vaccination. RESULTS: Among the 744 adults aged 65 and over in this sample, 32% reported being vaccinated for HZ, including 23% of participants aged 65-74, 55% of participants aged 75-84, and 0% for participants aged 85 and above. Those who are vaccinated with other immunisations are more likely to have received HZ vaccine, including seasonal influenza (OR = 4.41, 95 % CI: 2.44-7.98) and pneumococcal vaccines (OR = 4.43, 95 % CI: 2.92 - 6.75). Participants with a history of certain conditions, such as stroke (OR = 2.26, 95 % CI: 1.13-4.49), were more likely to be vaccinated against HZ. Participants that reported smoking tobacco daily were less likely to be vaccinated against HZ (OR = 0.48, 95 % CI: 0.26-0.89). Participants were less likely to be vaccinated against HZ if they preferred to develop immunity 'naturally' (OR = 0.29, 95 % CI: 0.15 - 0.57) or expressed distrust of vaccines (OR = 0.34, 95 % CI: 0.13-0.91). CONCLUSION(S): Further research is required to understand the barriers to HZ vaccine uptake. Increasing the funding eligibility for those who are at risk of complications from shingles, or lowering the age of eligibility, may increase vaccine coverage.

Factors associated with repeated influenza vaccine uptake among aged care staff in an Australian sample from 2017 to 2019.

BACKGROUND/AIM: Influenza vaccination is strongly recommended every year for aged care staff to protect themselves and minimise risk of transmission to residents. This study aimed to determine the factors associated with repeated annual influenza vaccine uptake among Australian aged care staff from 2017 to 2019. METHODS: Demographic, medical and vaccination data collected from the staff, who participated in an observational study from nine aged care facilities under a single provider in Sydney Australia, were analysed retrospectively. Based on the pattern of repeated influenza vaccination from 2017 to 2019, three groups were identified: (1) unvaccinated all three years; (2) vaccinated occasionally(once or twice) over three years; and (3)vaccinated all threeyears. Multinomial logistic regression analysis was performed to better understand the factors associated with the pattern of repeated influenza vaccination. RESULTS: From a total of 138 staff, between 2017 and 2019, 28.9 % (n = 40) never had a vaccination, while 44.2 % (n = 61) had vaccination occasionally and 26.8 % (n = 37) had vaccination all three years. In the multinomial logistic regression model, those who were<40 years old (OR = 0.57, 95 % CI: 0.19-0.90, p < 0.05) and those who were current smokers (OR = 0.20; 95 % CI: 0.03-0.76, p < 0.05) were less likely to have repeated vaccination for all three years compared to the unvaccinated group. Those who were<40 years old (OR = 0.61; 95 % CI: 0.22-0.68, p < 0.05) and those who were born overseas (OR = 0.50; 95 % CI:0.27-0.69, p < 0.05) were more likely to be vaccinated occasionally compared to the unvaccinated group. CONCLUSION: The significant predictors of repeated vaccine uptake across the three-year study period among aged care staff were age, smoking status and country of birth (Other vs Australia). Targeted interventions towards the younger age group (<40 years old), smokers and those who were born overseas could improve repeated influenza vaccination uptake in the aged care workforce.

Diagnostic and Prognostic Value of Left Atrial Function in Identification of Cardioembolism and Prediction of Outcomes in Patients with Cryptogenic Stroke.

BACKGROUND: Stroke of undetermined source, commonly termed cryptogenic stroke (CS), accounts for a significant proportion of ischemic stroke etiology and have high rates of stroke recurrence. The heterogeneous etiology of CS makes decisions regarding treatment for such patients challenging. The aim of this study was to evaluate the diagnostic and prognostic value of left atrial (LA) function in the identification of cardioembolism and prediction of outcomes in patients with CS. METHODS: Consecutive patients admitted to a tertiary institution with ischemic stroke or transient ischemic attack (TIA) who underwent transthoracic echocardiography were recruited, with comprehensive evaluation of LA metrics including LA strain. Ischemic strokes and TIAs were classified as noncardioembolic, cryptogenic, or cardioembolic. A total of 709 patients (mean age, 66.0 ± 15.1 years; 55% men) were recruited. Two hundred ninety-one patients had CS, 189 had noncardioembolic stroke, and 229 had cardioembolic stroke. Patients with CS were followed for 20.0 ± 13.8 months for recurrent ischemic stroke or TIA. RESULTS: Receiver operating characteristic curves showed LA reservoir and contractile strain to be strong discriminators of cardioembolic strokes, and log-rank tests showed both measures to be significantly associated with the distribution of time to recurrent ischemic stroke or TIA in patients with CS. Multivariable hazard models showed LA reservoir and contractile strain to be independent predictors of recurrent ischemic stroke or TIA in patients with CS, in addition to estimated glomerular filtration rate and active smoking. CONCLUSIONS: LA reservoir and contractile strain were strong discriminators of cardioembolic stroke and independently predicted recurrent ischemic stroke or TIA in patients with CS. Use of LA strain may improve risk stratification and decision-making in patients with CS, with particular regard to prolonged ambulatory heart rhythm monitoring and/or empiric anticoagulation.

Protocol for SARS-CoV-2 post-vaccine surveillance study in Australian adults and children with cancer: an observational study of safety and serological and immunological response to SARS-CoV-2 vaccination (SerOzNET).

BACKGROUND: Cancer is associated with excess morbidity and mortality from coronavirus disease 2019 (COVID-19) following infection by the novel pandemic coronavirus SARS-CoV-2. Vaccinations against SARS-CoV-2 have been rapidly developed and proved highly effective in reducing the incidence of severe COVID-19 in clinical trials of healthy populations. However, patients with cancer were excluded from pivotal clinical trials. Early data suggest that vaccine response is less robust in patients with immunosuppressive conditions or treatments, while toxicity and acceptability of COVID-19 vaccines in the cancer population is unknown. Unanswered questions remain about the impact of various cancer characteristics (such as treatment modality and degree of immunosuppression) on serological response to and safety of COVID-19 vaccinations. Furthermore, as the virus and disease manifestations evolve, ongoing data is required to address the impact of new variants. METHODS: SerOzNET is a prospective observational study of adults and children with cancer undergoing routine SARS-CoV-2 vaccination in Australia. Peripheral blood will be collected and processed at five timepoints (one pre-vaccination and four post-vaccination) for analysis of serologic responses to vaccine and exploration of T-cell immune correlates. Cohorts include: solid organ cancer (SOC) or haematological malignancy (HM) patients currently receiving (1) chemotherapy, (2) immune checkpoint inhibitors (3) hormonal or targeted therapy; (4) patients who completed chemotherapy within 6-12 months of vaccination; (5) HM patients with conditions associated with hypogammaglobulinaemia or immunocompromise; (6) SOC or HM patients with allergy to PEG or polysorbate 80. Data from healthy controls already enrolled on several parallel studies with comparable time points will be used for comparison. For children, patients with current or prior cancer who have not received recent systemic therapy will act as controls. Standardised scales for quality-of-life assessment, patient-reported toxicity and vaccine hesitancy will be obtained. DISCUSSION: The SerOzNET study was commenced in June 2021 to prospectively study immune correlates of vaccination in specific cancer cohorts. The high proportion of the Australian population naïve to COVID-19 infection and vaccination at study commencement has allowed a unique window of opportunity to study vaccine-related immunity. Quality of life and patient-reported adverse events have not yet been reported in detail post-vaccination for cancer patients. Trial registration This trial is registered on the Australia New Zealand Clinical Trials Registry (ANZCTR) ACTRN12621001004853. Submitted for registration 25 June 2021. Registered 30 July 2021 (Retrospectively registered). https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=382281&isReview=true.

Prevention of SARS-CoV-2 transmission from international arrivals: Xiaotangshan Designated Hospital, China.

A surge in the number of international arrivals awaiting coronavirus disease 2019 (COVID-19) screening overwhelmed health-care workers and depleted medical resources in designated hospitals in Beijing, China in March 2020. The People's Government of Beijing Municipality therefore issued a policy which required the mandatory transfer of all asymptomatic passengers arriving from a foreign country to designated quarantine hotels, and the transfer of passengers with fever or respiratory symptoms to designated hospitals. Xiaotangshan Designated Hospital, a severe acute respiratory syndrome hospital in 2003, was rapidly renovated and put into operation with the main tasks of screening and isolating symptomatic international arrivals at Beijing Capital International Airport, providing basic medical care for mild to moderate COVID-19-positive cases, and rapidly referring severe to critical COVID-19-positive cases to higher-level hospitals. During the month-long period of its operation, 2171 passengers were screened and 53 were confirmed as having COVID-19 (six severe to critical). We describe how the use of Xiaotangshan Designated Hospital in this way enabled the efficient grouping and assessment of passengers arriving from a foreign country, the provision of optimal patient care without compromising public safety and the prioritization of critically ill patients requiring life-saving treatment. The designated hospital is a successful example of the World Health Organization's recommendation to renovate existing medical infrastructures to improve the COVID-19 response capacity. The flexible design of Xiaotangshan Designated Hospital means that it can be repurposed and reopened at any time to respond to the changing pandemic conditions.

En mars 2020, la brusque hausse du nombre d'arrivées internationales en attente de dépistage de la maladie à coronavirus 2019 (COVID-19) a submergé les professionnels de la santé et épuisé les ressources médicales dans les hôpitaux de référence à Beijing, en Chine. Le gouvernement populaire de la municipalité de Beijing a réagi en ordonnant que tous les passagers asymptomatiques en provenance d'un pays étranger soient transférés vers des hôtels reconvertis en centres de quarantaine, et que ceux manifestant de la fièvre ou des symptômes respiratoires soient envoyés dans des hôpitaux de référence. L'hôpital de référence Xiaotangshan, construit en 2003 pour lutter contre le syndrome respiratoire aigu sévère, a rapidement été rénové et mis en service. Ses tâches principales: dépister et isoler les passagers internationaux symptomatiques débarquant au Beijing Capital International Airport, prodiguer les soins médicaux de base aux cas positifs de COVID-19 souffrant d'une forme légère à modérée, et adresser dès que possible les cas positifs de COVID-19 dans un état grave ou critique aux hôpitaux spécialisés. En l'espace d'un mois, 2171 passagers ont été testés et 53 se sont révélés positifs à la COVID-19 (6 étant dans un état grave ou critique). Nous décrivons la façon dont l'hôpital de référence Xiaotangshan a ainsi permis de regrouper et d'évaluer efficacement les arrivées en provenance de l'étranger, d'offrir une prise en charge optimale des patients sans compromettre la sécurité publique, et d'établir des priorités afin que les malades gravement atteints puissent bénéficier d'un traitement dans les plus brefs délais. Cet hôpital de référence est un exemple réussi de la mise en œuvre de la recommandation formulée par l'Organisation mondiale de la Santé: rénover les infrastructures médicales existantes afin d'améliorer les capacités de lutte contre la COVID-19. Grâce à sa conception flexible, l'hôpital Xiaotangshan peut être réutilisé et rouvert à n'importe quel moment pour réagir à un contexte pandémique en perpétuelle évolution.

Un aumento del número de llegadas de vuelos internacionales en espera de la detección del coronavirus 2019 (COVID-19) sobrecargó al personal sanitario y agotó los recursos médicos en los hospitales designados de Pekín (China) en marzo de 2020. Por lo tanto, la policía del Gobierno Popular del municipio de Pekín se tuvo que hacer cargo del traslado obligatorio de todos los pasajeros asintomáticos que llegaran de un país extranjero a los hoteles de cuarentena designados, y el traslado de los pasajeros con fiebre o síntomas respiratorios a los hospitales designados. El hospital designado de Xiaotangshan, un hospital especializado en el síndrome respiratorio agudo severo en 2003, se rehabilitó rápidamente y se puso en funcionamiento con las tareas principales de examinar y aislar a los sintomáticos que llegaban al Aeropuerto Internacional de Pekín, proporcionando atención médica básica a los casos positivos de COVID-19 de leves a moderados, y derivando rápidamente los casos positivos de COVID-19 de graves a críticos a hospitales de nivel superior. Durante el mes que duró su funcionamiento, se examinó a 2.171 pasajeros y se confirmó que 53 tenían la COVID-19 (6 de ellos con intensidad de grave a crítica). Describimos cómo el uso del hospital designado de Xiaotangshan permitió agrupar y evaluar eficazmente a los pasajeros que llegaban de un país extranjero, prestar una atención óptima a los pacientes sin comprometer la seguridad pública y priorizar a los pacientes en estado crítico que requerían tratamiento para salvar su vida. El hospital designado es un ejemplo de éxito de la recomendación de la Organización Mundial de la Salud de renovar las infraestructuras médicas existentes para mejorar la capacidad de respuesta ante la COVID-19. El diseño flexible del hospital designado de Xiaotangshan significa que puede utilizarse y volver a habilitarse en cualquier momento para responder a las condiciones cambiantes de la pandemia.

Estimating the burden of COVID-19 on the Australian healthcare workers and health system during the first six months of the pandemic.

INTRODUCTION: There are no publicly available national data on healthcare worker infections in Australia. It has been documented in many countries that healthcare workers (HCW) are at increased occupational risk of COVID-19. We aimed to estimate the burden of COVID-19 on Australia HCW and the health system by obtaining and organizing data on HCW infections, analyzing national HCW cases in regards to occupational risk and analyzing healthcare outbreak. METHODS: We searched government reports and websites and media reports to create a comprehensive line listing of Australian HCW infections and nosocomial outbreaks between January 25th and July 8th, 2020. A line list of HCW related COVID-19 reported cases was created and enhanced by matching data extracted from media reports of healthcare related COVID-19 relevant outbreaks and reports, using matching criteria. Rates of infections and odds ratios (ORs) for HCW were calculated per state, by comparing overall cases to HCW cases. To investigate the sources of infection amongst HCW, transmission data were collated and graphed to show distribution of sources. RESULTS: We identified 36 hospital outbreaks or HCW infection reports between January 25th and July 8th, 2020. According to our estimates, at least 536 HCW in Australia had been infected with COVID-19, comprising 6.03% of all reported infections. The rate of HCW infection was 90/100000 and of community infection 34/100,000. HCW were 2.69 times more likely to contract COVID-19 (95% CI 2.48 to 2.93; P < 0.001). The timing of hospital outbreaks did not always correspond to community peaks. Where data were available, a total of 131 HCW across 21 outbreaks led to 1656 HCW being furloughed for quarantine. In one outbreak, one hospital was closed and 1200 HCW quarantined. CONCLUSION: The study shows that HCW were at nearly 3 times the risk of infection. Of concern, this nearly tripling of risk occurred during a period of low community prevalence suggesting failures at multiple hazard levels including PPE policies within the work environment. Even in a country with relatively good control of COVID-19, HCW are at greater risk of infection than the general community and nosocomial outbreaks can have substantial effects on workforce capacity by the quarantine of numerous HCW during an outbreak. The occurrence of hospital outbreaks even when community incidence was low highlights the high risk setting that hospitals present. Australia faced a resurgence of COVID-19 after the study period, with multiple hospital outbreaks. We recommend formal reporting of HCW infections, testing protocols for nosocomial outbreaks, cohorting of workforce to minimize the impact, and improved PPE guidelines to provide precautionary and optimal protection for HCW.

Practical Considerations for Treating Patients With Cancer in the COVID-19 Pandemic.

Cancer has become a prevalent disease, affecting millions of new patients globally each year. The COVID-19 pandemic is having far-reaching impacts around the world, causing substantial disruptions to health and health care systems that are likely to last for a prolonged period. Early data have suggested that having cancer is a significant risk factor for mortality from severe COVID-19. A diverse group of medical oncologists met to formulate detailed practical advice on systemic anticancer treatments during this crisis. In the context of broad principles, issues including risks of treatment, principles of prioritizing resources, treatment of elderly patients, and psychosocial impact are discussed. Detailed treatment advice and options are given at a tumor stream level. We must maintain care for patients with cancer as best we can and recognize that COVID-19 poses a significant competing risk for death that changes conventional treatment paradigms.

Long term follow up of persistence of immunity following quadrivalent Human Papillomavirus (HPV) vaccine in immunocompromised children.

BACKGROUND: Human Papillomavirus (HPV) causes significant burden of HPV-related diseases, which are more prevalent in immunosuppressed compared to immunocompetent people. We conducted a multi-centre clinical trial to determine the immunogenicity and reactogenicity of HPV vaccine in immunocompromised children. Here we present the immunogenicity results 5 years post vaccination. METHODS: We followed up immunocompromised children (5-18 years) with a range of specified underlying conditions who were previously recruited from three Australian paediatric hospitals. Participants received three doses of quadrivalent HPV vaccine (Gardasil Quadrivalent HPV Types 6, 11, 16, 18) and were followed up between 2007 and 2016 (60 months post-vaccination). The immunogenicity primary outcome was seroconversion and geometric mean titres (GMT) of the quadrivalent HPV vaccine serotypes in the study. RESULTS: Of the 59 original participants, 37 were followed up at 60 months. The proportion of participants who seroconverted were: 86.5%, 89.2%, 89.2%, 91.9% by competitive Luminex immunoassay (cLIA) and 83.8%, 83.8%, 94.6%, 78.4% by total immunoglobulin G assays (IgG) for serotypes 6, 11, 16 and 18 respectively. GMT values ranged from 118 (95%CI: 79-177) for serotype 11, to 373 (95%CI: 215-649) for serotype 16 by cLIA. For IgG, serotype 16 had the highest GMT of 261 (95%CI: 143-477) and serotype 18 had the lowest value of 37 (95%CI: 21-68). All antibody titres were lower in females compared to males but the difference was not statistically significant except for serotype 16. No serious adverse event was reported during this follow-up period. CONCLUSION: Our evidence, although limited by small numbers, is reassuring that a three dose schedule of HPV vaccine remains immunogenic in immunocompromised children to five years post vaccination. Large scale studies are required to determine long term protection in immunocompromised children. CLINICAL TRIAL REGISTRATION: NCT02263703 (ClinicalTrials.gov).

Contamination by respiratory viruses on outer surface of medical masks used by hospital healthcare workers.

BACKGROUND: Medical masks are commonly used in health care settings to protect healthcare workers (HCWs) from respiratory and other infections. Airborne respiratory pathogens may settle on the surface of used masks layers, resulting in contamination. The main aim of this study was to study the presence of viruses on the surface of medical masks. METHODS: Two pilot studies in laboratory and clinical settings were carried out to determine the areas of masks likely to contain maximum viral particles. A laboratory study using a mannequin and fluorescent spray showed maximum particles concentrated on upper right, middle and left sections of the medical masks. These findings were confirmed through a small clinical study. The main study was then conducted in high-risk wards of three selected hospitals in Beijing China. Participants (n = 148) were asked to wear medical masks for a shift (6-8 h) or as long as they could tolerate. Used samples of medical masks were tested for presence of respiratory viruses in upper sections of the medical masks, in line with the pilot studies. RESULTS: Overall virus positivity rate was 10.1% (15/148). Commonly isolated viruses from masks samples were adenovirus (n = 7), bocavirus (n = 2), respiratory syncytial virus (n = 2) and influenza virus (n = 2). Virus positivity was significantly higher in masks samples worn for > 6 h (14.1%, 14/99 versus 1.2%, 1/49, OR 7.9, 95% CI 1.01-61.99) and in samples used by participants who examined > 25 patients per day (16.9%, 12/71 versus 3.9%, 3/77, OR 5.02, 95% CI 1.35-18.60). Most of the participants (83.8%, 124/148) reported at least one problem associated with mask use. Commonly reported problems were pressure on face (16.9%, 25/148), breathing difficulty (12.2%, 18/148), discomfort (9.5% 14/148), trouble communicating with the patient (7.4%, 11/148) and headache (6.1%, 9/148). CONCLUSION: Respiratory pathogens on the outer surface of the used medical masks may result in self-contamination. The risk is higher with longer duration of mask use (> 6 h) and with higher rates of clinical contact. Protocols on duration of mask use should specify a maximum time of continuous use, and should consider guidance in high contact settings. Viruses were isolated from the upper sections of around 10% samples, but other sections of masks may also be contaminated. HCWs should be aware of these risks in order to protect themselves and people around them.

Influenza vaccine as a coronary intervention for prevention of myocardial infarction.

Cardiovascular disease (CVD) is the leading cause of morbidity and mortality globally. Influenza is one of the leading infectious causes of morbidity and mortality globally, and evidence is accumulating that it can precipitate acute myocardial infarction (AMI). This is thought to be due to a range of factors including inflammatory release of cytokines, disruption of atherosclerotic plaques and thrombogenesis, which may acutely occlude a coronary artery. There is a large body of observational and clinical trial evidence that shows that influenza vaccine protects against AMI. Estimates of the efficacy of influenza vaccine in preventing AMI range from 15% to 45%. This is a similar range of efficacy compared with the accepted routine coronary prevention measures such as smoking cessation (32-43%), statins (19-30%) and antihypertensive therapy (17-25%). Influenza vaccine should be considered as an integral part of CVD management and prevention. While it is recommended in many guidelines for patients with CVD, rates of vaccination in risk groups aged <65 years are very low, in the range of 30%. The incorporation of vaccination into routine CVD prevention in patient care requires a clinical practice paradigm change.

Immunogenicity and persistence of immunity of a quadrivalent Human Papillomavirus (HPV) vaccine in immunocompromised children.

AIM: The aim of this study was to determine the immunogenicity and reactogenicity of HPV vaccine in immunocompromised children. METHODS: A multi-centre clinical trial was conducted in three paediatric hospitals in Australia. Unvaccinated children 5-18years of age attending one of three paediatric hospitals with a range of specified conditions associated with immunosuppression were included. Quadrivalent HPV vaccine (Gardasil) was given to the participants and serum anti-HPV antibody levels were measured at baseline (before first dose), 7 and 24months after the first dose of vaccine. RESULTS: Fifty-nine participants were enrolled across the three paediatric hospitals and among those one was seropositive to types 6, 11 and 16 at baseline. Seven months after the first dose, seroconversion rates were 93.3%, 100%, 100% and 88.9% for type 6, 11, 16 and 18 respectively. The corresponding rates at 24month follow up were 82.2%, 91.1%, 91.1% and 68.9%. The greatest increase in geometric mean titre (GMT) was for type 16, followed by type 11. GMTs declined over the following months, but remained more than fourfold higher for all serotypes compared to baseline titres at 24months post vaccination. Injection site erythema, pain and swelling were commonly reported local adverse events and were less common after each dose. Few participants reported systemic adverse events, and minor disease flare occurred in two participants. One child developed a squamous cell oral carcinoma during follow up, but tissue was unable to be tested for HPV. CONCLUSION: Immunosuppressed children had an adequate immunogenic response to Quadrivalent HPV vaccine regardless of age and the cause of immunosuppression. HPV related cancers occur at higher frequency and earlier in immunosuppressed patients, so early vaccination and optimal scheduling should be further studied in such children. CLINICAL TRIAL REGISTRATION: NCT02263703 (ClinicalTrials.gov).

Risk factors for pertussis hospitalizations in Australians aged 45 years and over: A population based nested case-control study.

Although studies have described factors associated with pertussis hospitalization in children, data on adult hospitalization are sparse. We examined the association between patient characteristics and hospitalization among older adults with pertussis. We conducted a nested case-control study of participants in the 45 and Up prospective cohort in New South Wales, Australia, with an incident pertussis diagnosis during 2006-2012. Cases were defined as those with a hospitalization coded as 'whooping cough' or 'non-specific respiratory disease/cough' between a week prior and 6 weeks after the diagnosis of pertussis based on laboratory tests. Controls were participants diagnosed with pertussis but not hospitalized. Among 265,287 participants, the incidence of pertussis and pertussis hospitalization was 83.9 (95% [confidence interval] CI, 78.7-89.6) and 2.9 (95% CI, 2.1-4.1)/100,000 person-years, respectively. Among 33 cases and 882 controls, factors associated with hospitalization were increasing age (compared to those 45-54 years, adjusted odds ratio [aOR] 5.4 (95% CI, 1.6-18.2) and 8.9 (95% CI, 2.3-34.7) in those aged 65-74 years and 75+ years, respectively) and smoking (ever versus never, aOR 2.37 (95% CI, 1.11-5.06)). The risk of pertussis hospitalization is substantially higher in ≥65 years old. A booster dose of diphtheria-tetanus-pertussis vaccine could be readily integrated into routine vaccination for this age group.

A case-control study of the role of human papillomavirus in oesophageal squamous cell carcinoma in australia.

Objective. We investigate the prevalence of human papillomavirus (HPV) in oesophageal squamous cell carcinoma (OSCC) tissues compared to oesophageal tissue from healthy controls, in an Australian cohort. Methods. We conducted a hospital-based case-control study of 99 patients with OSCC and 100 healthy controls to examine the presence of HPV DNA. Paraffin tissues were tested using the PapType high-risk HPV detection and genotyping kit and with INNO-LiPA HPV Genotyping Extra. The biopsy samples were tested for HPV using a PCR-ELISA method based on the L1 consensus primer set PGMY09-PGMY11. Results. HPV DNA of the oncogenic genotype 16 was detected in 1/99 case specimens, a rate of 1010 per 100,000 (95% CI: 30-5500). All control specimens were negative for HPV. Significantly higher rates of smoking, other aerodigestive cancers, and mortality were seen among cases than controls. A pooled analysis of this study and the only other Australian case-control study found that 9/321 cases and 0/155 controls were positive for HPV. The pooled odds ratio for HPV being a risk factor for OSCC was 9.35 (95% CI: 0.47-190.33). Conclusion. Our results suggest that in this multifactorial cancer HPV may be an additional risk factor; although a larger, better powered study is needed.

Evidence for the aetiology of human papillomavirus in oesophageal squamous cell carcinoma in the Chinese population: a meta-analysis.

OBJECTIVES: We aimed to conduct a meta-analysis of human papillomavirus (HPV) as a risk factor for oesophageal squamous cell carcinoma (OSCC) in China, using all eligible studies published in the English and Chinese language literature. DESIGN: The random effect model was used to analyse the pooled OR. The I(2) and Q tests were included in the subgroup analyses. SETTING: Literature searches of databases including MEDLINE, PUBMED, EMBASE and Chinese National Knowledge Infrastructure (CNKI) and other available resources were performed to retrieve studies investigating OSCC tissue from Chinese participants for the presence of HPV DNA. PRIMARY OUTCOME MEASURE: A collective analysis of OSCC cases and control specimens was carried out from 15 case-control studies (6 in the English language and 9 in the Chinese language) for HPV prevalence. RESULTS: Of a total of 1177 OSCC and 1648 oesophageal control samples, 55% (642/1177) of cancer specimens and 27% (445/1648) of control samples were positive for HPV DNA. A positive strong association between HPV DNA and OSCC was observed among the included studies, with a pooled OR of 3.69 (95% CI 2.74 to 4.96). Heterogeneity and publication bias were not observed in the analysis. Subgroup analyses of the included studies also supported the measure of association of causal links between HPV and OSCC. CONCLUSIONS: This meta-analysis provides the strongest evidence until now of an association between HPV and OSCC in the Chinese population. China has a high burden of OSCC, making this an important research finding. A strength and new contribution of this study is combining data from the English and Chinese language literature to analyse all studies conducted in China. These findings may inform the population level use of prophylactic HPV vaccination to reduce the burden of OSCC in China.

The aetiological role of human papillomavirus in oesophageal squamous cell carcinoma: a meta-analysis.

BACKGROUND: The aetiological role of human papillomavirus (HPV) in oesophageal squamous cell carcinoma (OSCC) has been widely researched for more than three decades, with conflicting findings. In the absence of a large, adequately powered single case-control study, a meta-analysis of all available case-control studies is the most rigorous way of identifying any potential association between HPV and OSCC. We present the first global meta-analysis of case-control studies investigating the role of HPV in OSCC. METHODS: Case-control studies investigating OSCC tissue for presence of HPV DNA were identified. 21 case-control studies analyzing a total of 1223 cases and 1415 controls, met our inclusion criteria. HPV detection rates were tabulated for each study and all studies were assessed for quality. The random effects method was used to pool the odds ratios (OR). RESULTS: From all OSCC specimens included in this meta-analysis, 35% (426/1223) were positive for HPV DNA. The pooled OR for an HPV-OSCC association was 3.04 (95% CI 2.20 to 4.20). Meta-regression analysis did not find a significant association between OR and any of the quality domains. Influence analysis was non-significant for the effect of individual studies on the pooled estimate. Studies conducted in countries with low to medium OSCC incidence showed a stronger relationship (OR 4.65, 95% CI 2.47 to 8.76) than regions of high OSCC incidence (OR 2.65, 95% CI 1.80 to 3.91). CONCLUSIONS: Uncertainty around the aetiological role of HPV in OSCC is due largely to the small number and scale of appropriately designed studies. Our meta-analysis of these studies suggests that HPV increases the risk of OSCC three-fold. This study provides the strongest evidence to date of an HPV-OSCC association. The importance of these findings is that prophylactic vaccination could be of public health benefit in prevention of OSCC in countries with high OSCC incidence.